3 good reasons to join a medical scheme

Last Christmas, Niels Colesky, 40, was mountain biking in Tokai when he overshot a corner, put his foot down to stop himself falling, and heard an ominous crack. “I’d messed up my other knee in a motorbike accident in my 20s, and I knew immediately I had done serious damage,” he says.

Colesky is a small business owner, and a medical scheme was one of the “luxuries” he didn’t allow himself. But knee surgery of the kind he needed to be able to live painlessly again – and to be able to pursue his cycling passion – is not on short order in the state health care system.

So he went private. Tens of thousands of rands later, though immensely grateful to the excellent surgery and care he received, he was rueful about the bills. Joining a medical scheme shot right up on his priority list – it’s no longer something he feels to be a luxury.

Medical schemes are not a passport to “free” top-of-the-range healthcare for all conditions and circumstances, points out Andrew Edwards, Executive Principal Officer of Liberty Medical Scheme. “But they are your ticket to being able to make choices about the kind of healthcare you need, in both a day-to-day sense and in emergencies.”

With no offence intended to the excellent people working under trying circumstances in State facilities, private healthcare is one of the great gifts we can give ourselves. When we’re ill, or hurt in an accident, or having routine surgery, or even having a baby, we are, and feel, particularly vulnerable.

We want good medicine, pleasant surroundings, an antiseptic environment, palatable food, and we want a good bedside manner – someone who takes time to listen to our questions, answer our fears, and explain our options. And we want it now, not when we get to the top of some endless and chaotic waiting list.

And if that’s true for how you feel when you’re in hospital, imagine how you would feel if it was your child who had hurt him or herself, or developed one of those dreaded childhood conditions. While you might feel strong enough to fight your own battles on your own account, there isn’t a parent in the world who wouldn’t sell their own grandmother in order to provide the best possible care for their child.

Insurance rewards loyalty

It is true of almost all insurances that from a big-picture perspective, it makes sense to get in while you’re still pretty confident your demands will be light. Young, healthy, fit people may find that apart from routine check-ups, they never need to go to the doctor or dentist.

But as time passes, and you start planning babies, or you grow a family which has its own healthcare needs, and your health is perhaps a little less glowing, a medical scheme seems a much more attractive idea. Fair enough, but by then you yourself look much less attractive to the people who decide what sort of risk you represent, and you’ll find that reflected in your premiums. Insurance is one of those things that rewards loyalty.

Ruth Waldek, 50, a freelance systems analyst, has never been a member of a medical scheme. She’s a hiker, a non-smoker, and pretty health-conscious; and she argued that she’d be better off putting the money she would have spent on a medical scheme, into an investment account, where she could draw on it if necessary.

Many people think that way, and those who are disciplined enough to put the money away, as planned, may well do OK.

But it didn’t work out that way for Ruth. A bad stomach ache got worse, and when it became acute, she was diagnosed as having a dangerously inflamed appendix. Only after about 24 hours on an antibiotic drip in intensive care, was she was considered stable enough to be operated on. It went well, and the next day she went home.

And then the bills came. They were eye-watering. She challenged them, spoke to people, compared notes, and discovered one very good reason to belong to a medical scheme: medical charges to scheme members are lower.

“Because a medical scheme has thousands of members, it is in a good position to negotiate preferential rates with hospitals,” says Edwards. “Individual patients are in no position to negotiate. And so non-scheme patients pay more.”

The message is clear: for your own peace of mind, and for the good of those who depend on you, put yourself into a position of being able to afford the best health care available.

(Heather Parker, Health24, July 2010)

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